B. Intravenous diltiazem or metoprolol

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3. B. Initiation of sotalol

Certain antiaritmic drugs are considered not safe in the setting of left ventricular hypertrophy. These include class IC drugs (flecainide, propafenone, moricizine) and the class III drug sotalol. Amiodarone is safe. Dronedarone is not been evaluated. Class 1A drugs (quinidine, procainamide, disopyramide) are not well evaluated and usually avoided in this situation.

Elective direct current cardioversion without antiarrythmic drug therapy is reasonable; however, given the left atrial enlargement close to the severe range, this would likely not be successful in the long term.

Amiodarone and dofetilide are considered safe to use with LVH.

Pulmonary vein isolation (a.k.a. atrial fibrillation ablation) is indicated when one antiarrhythmic drug fails or is not tolerated due to side effects. It would also be reasonable to try a second antiarrhythmic drug.

4. B. Intravenous diltiazem or metoprolol

In patients with uncontrolled ventricular rates, AV blocking agents are important to slow the heart rate and decrease symptoms from atrial fibrillation. IV nondihydropyridine CCB (diltiazem, verapamil) or BB work well for this purpose. If a rate control strategy fails, then a rhythm control strategy with antiarrhythmic drugs such as amiodarone or procainamide may be reasonable once his illness resolves.

5. B. Initiation of sotalol

Certain AD are considered not safe in the setting of left ventricular hypertrophy. These include class IC drugs (flecainide, propafenone, moricizine) and the class III drug sotalol. Amiodarone is safe. Dronedarone is not been evaluated. Class 1A drugs (quinidine, procainamide, disopyramide) are not well evaluated and usually avoided in this situation.

Elective direct current cardioversion without antiarrythmic drug therapy is reasonable; however, given the left atrial enlargement close to the severe range, this would likely not be successful in the long term.

Amiodarone and dofetilide are considered safe to use with LVH.

Pulmonary vein isolation (a.k.a. atrial fibrillation ablation) is indicated when one antiarrhythmic drug fails or is not tolerated due to side effects. It would also be reasonable to try a second antiarrhythmic drug.

6. the same with 3

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